Critical care : the official journal of the Critical Care Forum
-
Multicenter Study Observational Study
Predictors of physical restraint use in Canadian intensive care units.
Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use. ⋯ PR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.
-
Oxidative stress has been postulated as a mechanism of organ dysfunction - and thus a potential therapeutic target - in sepsis. Lorente and colleagues report increased serum levels of malondialdehyde, a biomarker of oxidative stress-induced lipid peroxidation, in adults with severe sepsis, particularly in non-survivors. ⋯ These findings suggest that there is increased oxidative stress in sepsis and that membrane lipids in particular are targeted by free radical species. Further study is required to validate the utility of malondialdehyde as a prognostic biomarker in sepsis and to determine a role for antioxidant therapy.
-
Comment
Is intra-abdominal hypertension a missing factor that drives multiple organ dysfunction syndrome?
In a recent issue of Critical Care, Cheng and colleagues conducted a rabbit model study that demonstrated that intra-abdominal hypertension (IAH) may damage both gut anatomy and function. With only 6 hours of IAH at 25 mmHg, these authors observed an 80% reduction in mucosal blood flow, an exponential increase in mucosal permeability, and erosion and necrosis of the jejunal villi. Such dramatic findings should remind all caring for the critically ill that IAH may severely damage the normal gut barrier functions and thus may be reasonably expected to facilitate bacterial and mediator translocation. The potential contribution of IAH as a confounding factor in the efficacy of selective decontamination of the digestive tract should be considered.
-
The prevention of ischemic injury to preserve both end-organ function and improve neurological recovery by the implementation of therapeutic hypothermia has been well established in the literature. However, not only the means by which body temperature is cooled but also the rate by which target temperature is attained remains an area of continued interest and research. The induction of therapeutic hypothermia to begin the process of body temperature lowering through the infusion of a cold solution intravenously into the body may be one variable that influences not only rapidity of cooling but also subsequent clinical outcome. In a recent issue of Critical Care, Skulec and colleagues compared the induction of therapeutic hypothermia by cold normal saline versus cold colloid solution containing hydroxyethyl starch in a porcine animal model of cardiac arrest, assessing both the rate of temperature change and target temperature achieved, in addition to changes in intracranial pressure.